Carpal tunnel surgery

Carpal tunnel syndrome occurs when the median nerve, which passes through the wrist in a narrow channel called the carpal tunnel, becomes compressed. The roof of this channel is formed by the transverse carpal ligament, a strong fibrous band.

Surgical treatment consists of decompressing the median nerve: the surgeon divides the transverse carpal ligament, so that the channel widens and pressure on the nerve is reduced. At Detalii Med in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna.

The procedure is intended for patients with typical carpal tunnel symptoms that persist or worsen:

• numbness and tingling in the thumb, index, middle and part of the ring finger, especially at night or in the morning;
• waking from sleep with a “numb” hand that improves after shaking it;
• weakness of grip, dropping objects, difficulty with fine movements;
• symptoms that do not improve sufficiently with the conservative measures recommended by the doctor.

Whether surgery is indicated is decided individually, according to the duration and severity of symptoms and the results of investigations.

Median nerve decompression aims to stop the compression and usually relieves numbness and tingling, particularly night-time symptoms. Many patients notice an improvement within the first days or weeks.

The operation cannot always fully repair a nerve that has been affected for a long time. Where compression is long-standing, with loss of sensation or weakening of the muscles at the base of the thumb, recovery may be partial and slower. The procedure also does not treat numbness caused by other conditions, such as problems of the cervical spine or generalised neuropathies; this is why an accurate diagnosis is essential.

At the consultation, the doctor talks with the patient about the symptoms, when they began, the activities that make them worse and any associated conditions. This is followed by an examination of the hand: sensation in the fingers, grip strength, the appearance of the muscles and specific clinical tests.

The diagnosis is also supported by investigations, as advised by the doctor, for example electromyography, which shows how much conduction through the nerve is affected. The patient is asked about previous treatments, allergies and medication, especially medicines that affect blood clotting. Finally, the doctor explains whether surgery is suitable, how it is carried out and what can realistically be expected.

The procedure is usually performed as a day case. After the area has been prepared and disinfected, the surgeon makes an incision at the base of the palm, identifies the transverse carpal ligament and divides it, protecting the median nerve and surrounding structures.

The wound is closed with stitches and the hand is covered with a dressing. The operation is generally short, as a guide under an hour, depending on the case. The patient usually goes home on the same day, with written care instructions.

The operation is usually performed under local or regional anaesthesia, which numbs only the hand or arm. The patient remains awake but should not feel pain during the procedure, at most pressure or touch. The type of anaesthesia is chosen at the consultation, depending on the case and the preferences discussed with the doctor.

After the operation, the hand is kept raised for the first few days to reduce swelling. Gentle finger movement is usually encouraged from the start, to prevent stiffness. Discomfort is generally controlled with the painkillers recommended by the doctor.

• the dressing is changed and the wound checked at the agreed intervals;
• stitches are removed, as a guide, after about 10–14 days;
• light activities are resumed gradually, while effort with the hand and strong gripping are resumed after a few weeks, depending on progress and the type of work;
• tenderness around the scar may persist for a while.

Like any surgical procedure, carpal tunnel surgery carries risks, which are generally uncommon. They include:

• bleeding, haematoma or wound infection;
• tenderness or pain at the scar or at the base of the palm, which usually lessens over time;
• stiffness, swelling or a temporary reduction in strength;
• injury to nerves or blood vessels in the area, which is rare;
• incomplete improvement or recurrence of symptoms;
• complex regional pain syndrome, a rare complication.

The doctor explains the risks in detail at the consultation, according to each patient’s situation.

Night-time symptoms are often the first to improve, sometimes within the first few days. Recovery of sensation and grip strength is slower and may take from a few weeks to a few months, especially when compression was long-standing or severe.

The scar matures over several months, usually becoming less visible and less tender. Progress is monitored at the scheduled follow-up appointments.

Surgical treatment of carpal tunnel syndrome releases the median nerve by dividing the transverse carpal ligament. It is usually performed under local or regional anaesthesia, with discharge home on the same day. The outcome depends largely on how affected the nerve was before surgery, which is why timely assessment matters. The indication, the investigations needed and the recovery plan are agreed at the consultation at Detalii Med.